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I67.4 ICD-10-CM Code: Hypertensive encephalopathy

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 Excludes1 · 2 Excludes2 · 8 use-additional codes · 5 code-also instructions
Risk adjustment
RxHCC V08 category 187

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 070 — OTHER CEREBROVASCULAR DISORDERS WITH MCC (MDC 01)
  • MS-DRG 071 — OTHER CEREBROVASCULAR DISORDERS WITH CC (MDC 01)
  • MS-DRG 072 — OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC (MDC 01)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I67.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on I67.4 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable, associated hypertensive conditions such as:
  • essential (primary) hypertension (I10)
  • hypertensive chronic kidney disease (I12.-)
  • hypertensive heart and chronic kidney disease (I13.-)
  • hypertensive heart disease (I11.-)

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify presence of:
  • alcohol abuse and dependence (F10.-)
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco dependence (Z87.891)
  • hypertension (I10-I1A)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Source: inherited from I60-I69

Coder workflow for I67.4

MedCoder structured workflow — derived from this code’s own official record

Before you code I67.4

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I67.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in I67.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewI63.2, S06

Consider I67.4. Then work the Use Additional Code note and review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting I67.4(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I67.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI63.2, S06

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of I67.4(2 notes)

    Coding workflow: The conditions named in this note are not included in I67.4. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareG45.2, I69.8

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying I67.4(8 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with I67.4 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewF10, Z77.22, Z87.891, Z57.31, F17, Z72.0

    See the official tabular notes · Guidelines I.A.13

  • Code Also — related condition(5 notes)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    ReviewI10, I12, I13, I11

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition I67.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewI63.2, S06

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with I67.4?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewF10, Z77.22, Z87.891, Z57.31, F17, Z72.0

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Hypertensive encephalopathy is a billable ICD-10-CM diagnosis code (I67.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (5)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 9: Diseases of the Circulatory System (I00 -I99)

1) Category I69, Sequelae of Cerebrovascular disease Category I69 is used to indicate conditions classifiable to categories I60- I67 as the causes of sequela (neurologic deficits), themselves classified elsewhere. These “late effects” include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67. The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to categories I60-I67.

Chapter 9: Diseases of the Circulatory System (I00 -I99)

2) Codes from category I69 with codes from I60-I67 Codes from category I69 may be assigned on a health care record with codes from I60-I67, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 8 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 5 Code Also notes — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  3. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 2 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name I67.4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: G31.84 — Mild cognitive impairment of uncertain or unknown etiology (via I67.-), G93.2 — Benign intracranial hypertension.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Excludes2 notes across 2 chapters: G93.4 — Other and unspecified encephalopathy, I10 — Essential (primary) hypertension (via I67.-), I15 — Secondary hypertension (via I67.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: G46 — Vascular syndromes of brain in cerebrovascular diseases (via I67.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Code Also instruction: I16.1 — Hypertensive emergency.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 62 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 070 (MDC 01), DRG 071 (MDC 01), DRG 072 (MDC 01).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR008 — Hypertension with complications and secondary hypertension (default); NVS020 — Other nervous system disorders (neither hereditary nor degenerative).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

E13.52 — Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene, E13.59 — Other specified diabetes mellitus with other circulatory complications, E13.618 — Other specified diabetes mellitus with other diabetic arthropathy, E13.620 — Other specified diabetes mellitus with diabetic dermatitis, E13.621 — Other specified diabetes mellitus with foot ulcer, E13.622 — Other specified diabetes mellitus with other skin ulcer, E13.628 — Other specified diabetes mellitus with other skin complications, E13.630 — Other specified diabetes mellitus with periodontal disease, E13.638 — Other specified diabetes mellitus with other oral complications, E13.649 — Other specified diabetes mellitus with hypoglycemia without coma, E13.65 — Other specified diabetes mellitus with hyperglycemia, E13.69 — Other specified diabetes mellitus with other specified complication, E13.8 — Other specified diabetes mellitus with unspecified complications, I27.841 — Fontan-associated lymphatic dysfunction, I27.848 — Other Fontan-associated condition, I27.849 — Fontan related circulation, unspecified, I87.8 — Other specified disorders of veins, I87.9 — Disorder of vein, unspecified, I99.8 — Other disorder of circulatory system, I99.9 — Unspecified disorder of circulatory system, +41 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Hypertension with complications and secondary hypertension, Other nervous system disorders (neither hereditary nor degenerative)).

I15.0 — Renovascular hypertension, I15.1 — Hypertension secondary to other renal disorders, I15.2 — Hypertension secondary to endocrine disorders, I15.8 — Other secondary hypertension, I15.9 — Secondary hypertension, unspecified, I16.0 — Hypertensive urgency, I16.1 — Hypertensive emergency, I16.9 — Hypertensive crisis, unspecified, I1A.0 — Resistant hypertension, I67.3 — Progressive vascular leukoencephalopathy, I97.3 — Postprocedural hypertension, J10.81 — Influenza due to other identified influenza virus with encephalopathy, J11.81 — Influenza due to unidentified influenza virus with encephalopathy, K76.82 — Hepatic encephalopathy, M35.06 — Sjögren syndrome with peripheral nervous system involvement, M35.07 — Sjögren syndrome with central nervous system involvement, O10.111 — Pre-existing hypertensive heart disease complicating pregnancy, first trimester, O10.112 — Pre-existing hypertensive heart disease complicating pregnancy, second trimester, O10.113 — Pre-existing hypertensive heart disease complicating pregnancy, third trimester, O10.119 — Pre-existing hypertensive heart disease complicating pregnancy, unspecified trimester, +154 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Degeneration, degenerative”, “Hypertension, hypertensive”, “Lesion”; these codes share that main term but sit in a different category of the Tabular List.

I27.23 — Pulmonary hypertension due to lung diseases and hypoxia (pulmonary, group 3), I27.24 — Chronic thromboembolic pulmonary hypertension (pulmonary, group 4), I27.29 — Other secondary pulmonary hypertension (pulmonary, group 5), I27.83 — Eisenmenger's syndrome (pulmonary, with, right to left shunt related to congenital heart disease), I35.9 — Nonrheumatic aortic valve disorder, unspecified (aortic), I36.9 — Nonrheumatic tricuspid valve disorder, unspecified (tricuspid, nonrheumatic), I37.8 — Other nonrheumatic pulmonary valve disorders (pulmonary valve), I37.9 — Nonrheumatic pulmonary valve disorder, unspecified (pulmonary, valve), I51.5 — Myocardial degeneration (myocardial, myocardium), I51.9 — Heart disease, unspecified (cardiac), I70.0 — Atherosclerosis of aorta (aorta, aortic), I70.1 — Atherosclerosis of renal artery (Goldblatt's), I77.89 — Other specified disorders of arteries and arterioles (aorta, aortic, fatty), I78.8 — Other diseases of capillaries (capillaries), I87.30 — Chronic venous hypertension (idiopathic) without complications (venous, idiopathic, asymptomatic), I87.309 — Chronic venous hypertension (idiopathic) without complications of unspecified lower extremity (venous, idiopathic), I87.31 — Chronic venous hypertension (idiopathic) with ulcer (venous, idiopathic, with, ulcer), I87.32 — Chronic venous hypertension (idiopathic) with inflammation (venous, idiopathic, with, inflammation), I87.33 — Chronic venous hypertension (idiopathic) with ulcer and inflammation (venous, idiopathic, with, inflammation, with ulcer), I87.39 — Chronic venous hypertension (idiopathic) with other complications (venous, idiopathic, with, specified complication NEC), +314 more

Contextual Map

Every relationship of I67.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I67.4 with these 11 related codes in Claim Check

Hierarchy

Excludes2

Code Also

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 01 — Diseases and Disorders of the Nervous System[MDC crossing]: “Diseases and Disorders of the Nervous System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 8,892 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Degeneration, degenerative, cerebrovascular, due to hypertension[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Encephalopathy (acute), hypertensive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic), encephalopathy[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Lesion (s) (nontraumatic), brain, vascular, hypertensive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Lesion (s) (nontraumatic), cerebrovascular, hypertensive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (20)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "I67.4 — Hypertensive encephalopathy." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/i67.4-hypertensive-encephalopathy

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Hypertensive encephalopathy

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I67.4 in its code family, with their registry titles.

View all codes in the I67 family